HomeMy WebLinkAboutMortgage_Glaser (2) A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County , Township Year
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; FOR DEDUCTION FROM ASSESSED VALUATION FILE])I
State Form by De arb(R1116-09) II
Prescribed oy Departrent of Local Government Pounce A
File Mark
INSTRUCTIONS: I Form tiled with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where*FP p#4iisbcated.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. LL VU��JJ I County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought. �!//�/I(W�M`Y"slaM ❑ County Recorder
See reve e side for.dditional instructions and quali •=tions. GIBS()N
Ap
bays a vet ! .) COUNTY AU I h oR
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Assessed value of real property as of Mortgage/Contr indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appMant the sole
March 1,ctrtera year ManM 1 cu"�'�T date of application legal or equitable owner?
U�wv I ❑ Yes ❑ No
If no,what is his/her exit share of interest? f If owned with someone other than spouse,indicate with whom
If name on record is different than that of appLi ant indicate below-. Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
I Motile Horne(IC 61.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state.and ZIP code) —
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sweet city,stale,and ZIP code)
Does applicant own property in any other _I If yes,what,wmty? . What Taxing District? Has this:deduction been requested on property
county in Ind_ana? n__ — for current year./ ❑ Yes El No
i
`� /�;�'•••' COUNTY AUDITOR
Drawer.\O..••••••••
Ded
I
Card NO. .•35t3 20 20 i20 20
Signs County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner Acontract buyer of the aforementioned property on date application is filed. I
SIgnabredownees frog rune/))/...��/_� ,�,, n Date(nonth,day,year)
W resident address of applicant(number and street city,state,and ZIP code)
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Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry state,and ZIP code)